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Shiraki H.,Inagi Municipal Hospital | Yokozuka H.,Red Cross | Negishi K.,Yokohama Municipal Citizens Hospital | Inoue S.,Hino Municipal Hospital | And 3 more authors.
Circulation Journal

Background: Right ventricular myocardial infarction (RVMI) is the major cause of hypotension and/or shock (HpS) after acute inferior myocardial infarction (inferior AMI). It is, however, unclear how RVMI affects the acute hemodynamic course. Methods and Results: In the present study, 153 patients with inferior AMI caused by right coronary artery occlusion were examined. Associations between in-hospital outcome and HpS before admission (preER-HpS) or HpS after admission (postER-HpS) were assessed using multivariate logistic regression analysis. Multivariate analysis was also conducted to determine a predictor for postER-HpS, including clinical findings in the emergency room as independent variables. HpS developed in 48.4% of patients with inferior AMI. Patients with RVMI more frequently had HpS than their counterparts in the first 6 h after infarction onset. RVMI was, however, not associated with preER-HpS, but was independently with postER-HpS (odds ratio (OR): 10.1; 4.0-27.7), whereas left ventricular failure was associated with preER-HpS, but not with postER-HpS. Furthermore, RVMI (OR: 9.4; 3.6-27.1) identified at presentation predicted postER-HpS. Conclusions: Independent of concomitant left ventricular involvement, RVMI was significantly associated with postER-HpS, but not with preER-HpS. These findings highlight the importance of identifying RVMI immediately after admission in the setting of inferior AMI. Source

Shirotake S.,Inagi Municipal Hospital | Yoshimura I.,Inagi Municipal Hospital | Kosaka T.,Keio University | Matsuzaki S.,Inagi Municipal Hospital
Clinical and Experimental Nephrology

The case of a 63-year-old woman with a relatively rapidly growing angiomyolipoma (AML) originating from the right renal sinus is presented. The tumor had enlarged to more than fivefold in volume (7.4 × 6.7 × 10.1 cm) in the 7 years following its detection (5.6 × 3.4 × 4.6 cm) and had significantly pushed aside the duodenum and the inferior vena cava. The tumor was surgically resected together with the right kidney, and pathological examination revealed AML originating from the renal sinus. An AML involving or originating from the renal sinus is exceedingly rare; only 14 cases have been reported. Rapidly growing AMLs of the renal sinus are difficult to differentiate from liposarcoma because of similar findings in imaging studies. It should be noted that AML of the renal sinus can be a differential diagnosis of retroperitoneal fatty mass. Furthermore, an enlarged AML in the renal sinus may push aside other organs, such as the ileum, pancreas, and major vessels. Clinicians should determine whether these patients should be placed under active surveillance or be treated with invasive measures, such as radical nephrectomy. © 2011 Japanese Society of Nephrology. Source

Yoshida M.,International University of Health and Welfare | Kubota K.,International University of Health and Welfare | Kuroda J.,International University of Health and Welfare | Ohta K.,International University of Health and Welfare | And 7 more authors.
Journal of Gastroenterology and Hepatology (Australia)

Background and Aim: We seek for the accurate and simple method for detecting sentinel nodes of gastric cancer which can be popularized in community hospitals. The indocyanine green (ICG) fluorescence-guided method is reported to be sensitive. However, the ordinal fluorescence cameras have gray scale imaging and require a dark room. We have developed a new device, Hyper Eye Medical System (HEMS) which can simultaneously detect color and near-infrared rays and can be used under room light. This study was planned to examine whether submucosal injection of 0.5mL×4 of 50μg/mL ICG on the day before operation is the adequate administration for detecting sentinel nodes using HEMS in the gastric cancer surgery. Methods: The patients underwent gastrectomy for clinical T1a (mucosa)-T2 (muscularis propria) and clinical N0 were enrolled in the present study. As a preliminary trial, one case each of the ICG 25 and 100μg/mL, injected on the day before operation and intraoperative injection, was examined. Then, 10 cases injected 50μg/mL ICG on the day before operation were examined. Results: The ICG fluorescence of the patient injected 100μg/mL was too intense and that of the patient injected 25μg/mL was too faint. Sentinel lymph nodes were detected in all of 10 cases injected 50μg/mL, the day before operation and number of sentinel lymph nodes per patient was 3.6±2.1. Metastasis was observed in one case. All of ICG fluorescence-positive sentinel nodes were positive for the metastasis. In the patient who underwent intraoperative injection, sentinel lymphatic basins could be identified. Conclusion: The present study shows that HEMS-guided abdominal surgery is feasible under room light. Submucosal injection of 0.5mL×4 of 50μg/mL ICG on the day before operation is the adequate administration for detecting sentinel nodes using HEMS in the gastric cancer surgery. © 2012 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd. Source

Kawarazaki H.,Inagi Municipal Hospital | Kawarazaki H.,St. Marianna University School of Medicine | Uchino S.,Jikei University School of Medicine
Anaesthesiology Intensive Therapy

The 1980s saw the use of continuous arteriovenous hemofiltration whose intensity hemofiltration rate was only 3 or 4 mL kg-1 h-1 . With the installation of a blood pump, this dose went up to 8 or 10 mL kg-1 h-1 , and continued to increase, reaching about 20 mL kg-1 h-1 by the year 2000. Some studies found that a higher dose could be beneficial, and the world rapidly followed the trend, increasing the dose up to 35 mL kg-1 h-1 . Then, two randomized control trials, namely the VA/NIH Acute Renal Failure Trial Network study and the RENAL study, came along in succession which changed the Kidney Disease: Improving Global Outcomes (KDIGO) recommendation to 20 to 25 mL kg-1 h-1 . However, no good evidence exists to support this. Our recent multicenter retrospective studies from the JSEPTIC CRRT database show that the Japanese continuous renal replacement therapy dose of (14.3 mL kg-1 h-1 ) does not seem to have worse outcomes when compared with a higher dose. Source

Monma S.,Tokyo Metropolitan Tama Medical Center | Takanishi K.,Tokyo Metropolitan Tama Medical Center | Kurihara E.,Inagi Municipal Hospital | Kondou H.,Saitama University | And 4 more authors.
Japanese Journal of Gastroenterological Surgery

We followed up a 3 cm mucinous cystic neoplasm of the pancreas for 14 years with conservative observation. The tumor gradually enlarged and a solid component appeared 12 years after onset. The tumor enlarged to 8 cm and showed heterogeneity of the solid component 14 years later. Distal pancreatectomy was then performed and pathological findings showed papillary adenocarcinoma with minimal invasion. There was no evidence of ovarianlike stroma, but we made a diagnosis of mucinous cystic neoplasm due to the medical history and images. Metastasis had occurred to the lung, mediastinal lymph nodes and brain, and she survived for 42 months after surgery. The risk of carcinogenesis from the pancreatic mucinous cystic neoplasm is well recognized but its natural history is still unknown. The appearance of a mural nodule is an important sign of carcinogenic transformation. © 2016 The Japanese Society of Gastroenterological Surgery. Source

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